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Prevailing Wage Intake Form


									                                           Prevailing Wage Intake Form
                                             International Scholars Operations

Name of the H-1B Beneficiary: Family name/surname, First name/given name Middle initial (if any)
UW Appointment Title:Enter the official title
Job Class Code: XXXX
For proposed period of visa sponsorship

Your Name:First and last name
Your Title: Enter your official title
Unit representative preparing this form

The information below is needed to complete Department of Labor Form ETA 9141, Application for a Prevailing Wage
Determination. The “prevailing wage” is the average wage paid to similarly-employed workers in the occupation in the
geographic area of intended employment. When answering these questions, identify minimum and essential job
requirements only. Do not list items that are “desired” or “preferred.” Overstating the position’s requirements or job
duties may result in monetary and/or legal liabilities to the University of Washington (UW). Note that you are describing
the position and not the person selected to fill the position. If there was a published advertisement or position
description, provide answers consistent with those.

1.       What is the job title of the position’s supervisor (e.g., department chair or professor)?

         Enter the official title

2.       Will the position supervise the work of other employees?                YES        NO

In this context, "supervise" means managerial supervisory responsibilities (e.g., authority to hire, fire, lay off, transfer,
promote, discipline, train, schedule, assign, and/or evaluate employees).

                  If YES:

                  How many employees will the position supervise?

                  Do not include students the foreign national will supervise or mentor or graduate student employees
                  assigned by the unit to the foreign national. Enter the number of employees

                  What is/are the job title(s) of the employees being supervised? Enter the official title

3.       What is the offered wage for the position?
                 Wage per Month: $X,XXX.XX
                 Wage per Year: $XX,XXX.XX

Updated August 29, 2012     Prevailing Wage Intake Form Page 1 of 4

4.       Describe the job duties in detail using layman’s terms. Explain any abbreviations or acronyms. Include:
1.       Research goals and research to be performed;
2.       Techniques and tools to be used (this includes any non-standard software or hardware, programming languages, testing
         protocols, research equipment, and other technical details);
3.       If the position involves instruction in a laboratory setting, describe instruction to be performed; and
4.       If the position involves classroom teaching, list and describe classes to be taught.

For postdoctoral senior fellow or research associate appointments performing only research, please use any applicable information
from the following example:

This title at the UW is a postdoctoral research position (commonly called a “postdoc” or “research fellow”). It is a beginning-level
academic appointment providing an opportunity to a recent graduate for routine training in an academic environment. This entry-
level position is closely monitored and directly supervised by University faculty as part of the development process required to
become a professional researcher in the field of … The duties of the position include …
                  Enter description of the job duties in detail using layman's terms, following to the guidelines above

5.       Is travel required to perform the job?

                    YES     NO If YES, explain. Specify if there is only occasional travel to professional meetings or
                  conferences. Enter travel required to perform the job

6.       Are there any other working conditions that affect the rate of pay (e.g., hazard pay, cold weather pay,
         evening/weekend hours or rotating shifts that result in shift pay differentials, etc.)?
Note that this is uncommon at the UW.

                     YES       NO

                  If YES, explain: Enter other working conditions that affect the rate of pay

7.       What is the minimum degree requirement (or foreign-degree equivalent)?

                  Enter the minimum degree requirement

8.       If more than one degree is required (e.g., “M.D. and Ph.D.”), list all required degrees:

         Enter all required degrees, if more than one

9.       In the required degree checked or listed above, indicate all major field(s) of study acceptable (e.g., “biology or

Do not include any post-degree specialization. Be sure the field of the foreign national’s degree is among those listed as acceptable.

         Enter all major field(s) of study acceptable in the required degree

Updated August 29, 2012    Prevailing Wage Intake Form Page 2 of 4

10.      Is training required to perform the job?

Training includes vocational courses, apprenticeships, and similar activities. Training does not include any education or training that
was part of a degree listed above. It also does not include orientation time required for a fully qualified worker to become
accustomed to the special conditions of this job. Training includes medical residencies/fellowships only if there is a required duration
that is fixed in both U.S. and international residency/fellowship programs in the specialty; otherwise, enter it below in question 12.
Training also includes vocational courses, apprenticeships, and similar activities.

                     YES        NO

                   If YES, specify the following:         Months of Training: XX

                                                          Field of Training: Enter the official field name

11.      Is employment experience (essential experience in prior jobs) required for this position?

                     YES        NO

                   If YES, specify the following:         Months of Experience: XX

                                                          Occupation: Enter the official occupation

12.      List any other special requirements (e.g., professional license/certification, foreign language proficiency, board
         certification or board eligibility, etc.).

List only those special requirements that are necessary to perform the duties of this job competently. Do not duplicate requirements
listed elsewhere on this form. Here you may list specific skills that could have been gained in either a degree program or through a
prior job. Include medical residencies, fellowships, and other specialty training if there is no specific duration of training required;
otherwise, enter the residency or other training in question 9 above.

         Enter any other special requirements

13.      Do you have documentation evidencing that the foreign national currently possesses the degree(s) in the
         field(s) of study, training, employment experience, and other special requirements listed in questions 7-12

             YES       NO

         If NO, explain: Explain why you do not have documentation

14.      Street address, including zip code, where the employment will be performed.

List all locations and expected dates at each location.

         Enter the street address, including zip code, where the employment will be performed

Updated August 29, 2012     Prevailing Wage Intake Form Page 3 of 4

Updated August 29, 2012   Prevailing Wage Intake Form Page 4 of 4


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